Aapo L Aro1, Carmen Rusinaru2, Audrey Uy-Evanado2, Kyndaron Reinier2, Derek Phan2, Karen Gunson3, Jonathan Jui3, Sumeet S Chugh4. 1. Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland. 2. Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 3. Oregon Health and Science University, Portland, OR, USA. 4. Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: sumeet.chugh@cshs.org.
Abstract
BACKGROUND: Syncope has been associated with increased risk of sudden cardiac arrest (SCA) in specific patient populations, such as hypertrophic cardiomyopathy, heart failure, and long QT syndrome, but data are lacking on the risk of SCA associated with syncope among patients with coronary artery disease (CAD), the most common cause of SCA. We investigated this association among CAD patients in the community. METHODS: All cases of SCA due to CAD were prospectively identified in Portland, Oregon (population approximately 1 million) as part of the Oregon Sudden Unexpected Death Study 2002-2015, and compared to geographical controls. Detailed clinical information including history of syncope and cardiac investigations was obtained from medical records. RESULTS: 2119 SCA cases (68.4±13.8years, 66.9% male) and 746 controls (66.7±11.7years, 67.0% male) were included in the analysis. 143 (6.8%) of cases had documented syncope prior to the SCA. SCA cases with syncope were >5years older and had more comorbidities than other SCA cases. After adjusting for clinical factors and left ventricular ejection fraction (LVEF), syncope was associated with increased risk of SCA (OR 2.8; 95%CI 1.68-4.85). When analysis was restricted to subjects with LVEF ≥50%, the risk of SCA associated with syncope remained significantly elevated (adjusted OR 3.1; 95%CI 1.68-5.79). CONCLUSIONS: Syncope was associated with increased risk of SCA in CAD patients even with preserved LV function. These findings suggest a role for this clinical marker among patients with CAD and normal LVEF, a large sub-group without any current means of SCA risk stratification.
BACKGROUND:Syncope has been associated with increased risk of sudden cardiac arrest (SCA) in specific patient populations, such as hypertrophic cardiomyopathy, heart failure, and long QT syndrome, but data are lacking on the risk of SCA associated with syncope among patients with coronary artery disease (CAD), the most common cause of SCA. We investigated this association among CAD patients in the community. METHODS: All cases of SCA due to CAD were prospectively identified in Portland, Oregon (population approximately 1 million) as part of the Oregon Sudden Unexpected Death Study 2002-2015, and compared to geographical controls. Detailed clinical information including history of syncope and cardiac investigations was obtained from medical records. RESULTS: 2119 SCA cases (68.4±13.8years, 66.9% male) and 746 controls (66.7±11.7years, 67.0% male) were included in the analysis. 143 (6.8%) of cases had documented syncope prior to the SCA. SCA cases with syncope were >5years older and had more comorbidities than other SCA cases. After adjusting for clinical factors and left ventricular ejection fraction (LVEF), syncope was associated with increased risk of SCA (OR 2.8; 95%CI 1.68-4.85). When analysis was restricted to subjects with LVEF ≥50%, the risk of SCA associated with syncope remained significantly elevated (adjusted OR 3.1; 95%CI 1.68-5.79). CONCLUSIONS:Syncope was associated with increased risk of SCA in CAD patients even with preserved LV function. These findings suggest a role for this clinical marker among patients with CAD and normal LVEF, a large sub-group without any current means of SCA risk stratification.
Authors: Martin H Ruwald; Ken Okumura; Takeshi Kimura; Kazutaka Aonuma; Morio Shoda; Valentina Kutyifa; Anne-Christine H Ruwald; Scott McNitt; Wojciech Zareba; Arthur J Moss Journal: Circulation Date: 2013-11-07 Impact factor: 29.690
Authors: Martin Huth Ruwald; Morten Lock Hansen; Morten Lamberts; Carolina Malta Hansen; Michael Vinther; Lars Køber; Christian Torp-Pedersen; Jim Hansen; Gunnar Hilmar Gislason Journal: J Am Coll Cardiol Date: 2012-12-12 Impact factor: 24.094
Authors: Sumeet S Chugh; Jonathan Jui; Karen Gunson; Eric C Stecker; Benjamin T John; Barbara Thompson; Nasreen Ilias; Catherine Vickers; Vivek Dogra; Mohamud Daya; Jack Kron; Zhi-Jie Zheng; George Mensah; John McAnulty Journal: J Am Coll Cardiol Date: 2004-09-15 Impact factor: 24.094
Authors: Kyndaron Reinier; Gregory A Nichols; Adriana Huertas-Vazquez; Audrey Uy-Evanado; Carmen Teodorescu; Eric C Stecker; Karen Gunson; Jonathan Jui; Sumeet S Chugh Journal: Circulation Date: 2015-07-20 Impact factor: 29.690
Authors: Paolo Spirito; Camillo Autore; Claudio Rapezzi; Paola Bernabò; Roberto Badagliacca; Martin S Maron; Sergio Bongioanni; Fabio Coccolo; N A Mark Estes; Caterina S Barillà; Elena Biagini; Giovanni Quarta; Maria Rosa Conte; Paolo Bruzzi; Barry J Maron Journal: Circulation Date: 2009-03-23 Impact factor: 29.690
Authors: Sumeet S Chugh; Kyndaron Reinier; Audrey Uy-Evanado; Harpriya S Chugh; David Elashoff; Christopher Young; Angelo Salvucci; Jonathan Jui Journal: JACC Clin Electrophysiol Date: 2022-03-30
Authors: Elizabeth Davida Paratz; Luke Rowsell; Dominica Zentner; Sarah Parsons; Natalie Morgan; Tina Thompson; Paul James; Andreas Pflaumer; Christopher Semsarian; Karen Smith; Dion Stub; Andre La Gerche Journal: Open Heart Date: 2020-01-20